Breast Cancer Awareness

With the national breast cancer public awareness campaign turning 31 in 2015, it is appropriate to ask every woman visiting this page: How’s your breast awareness?

According to the U.S. Centers for Disease Control and Prevention, breast cancer is the leading form of cancer affecting women and the second deadliest, after lung cancer. Breast cancer affects approximately one in every eight women and will cause an estimated 40,000 deaths in 2015.

As a cardiologist, I’ve got to put in my two cents here and remind you all that, while cancer (generally) is the second leading cause of death in both women and men in the U.S., heart disease, unfortunately, remains the number one killer and is often overlooked as a significant women’s health issue. Hence, I want women (and men) to keep prevention of both heart disease and cancer in mind when going about their daily lives. But I diverge…

The good news is that breast cancer death rates have declined over the past two decades, especially in women under fifty; the American Cancer Society (ACS) attributes this to better early detection efforts. More than 2.8 million breast cancer survivors (those who have received or are receiving treatment) are estimated to be living in the U.S. today.

The Mammogram Controversy

The NBCAM program has shown great progress as a means of increasing public awareness about the need for early detection of breast cancer through regular self-breast exams and screening. However, NBCAM and some other organizations continue to recommend that women ages 40 and above receive annual mammograms despite controversy surrounding mammogram safety and effectiveness. Standard breast cancer screening tools, mammograms are X-rays of breasts that can help identify lumps which may be malignant tumors.

In November 2009, the United States Preventative Services Task Force (USPSTF) released recommendations about breast cancer screening based on impartial reviews of scientific evidence on the effectiveness of mammography. While USPSTF noted the existence of convincing evidence that mammography screening reduces breast cancer mortality, it found that the net benefit of such screening is much smaller for women ages 40 to 49 than for women ages 60 to 69. Reduction of net benefit in 40 to 49 year old women is due to harms associated with regular mammography screening, including “psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results.”3USPSTF also noted radiation exposure as a consideration. As 40 to 49 year old women experience greater incidence of false positive results, USPSTF recommended that women ages 50 to 74 receive mammogram screening every other year.

Through “Mammograms’ Value in Cancer Fight at Issue,” New York Times reporter Gina Kolata voiced similar mammography concerns derived from study results published in late September 2010.

More recently, a 2014 Canadian study of women between the ages of 40 and 59 showed that annual mammograms did not decrease death rate due to breast cancer any more than physical examinations followed by usual care in the community.

Over this 25 year study, the women were divided into groups by age: 40 to 49 years and 50 to 59 years. All those in the 40-49 year-old group received an initial physical examination and were taught self-breast examination; this group was randomly divided into a control group, which was told to remain under the care of their family doctors, and a mammogram group, which was offered annual mammograms and physical examinations. Women between the ages of 50 and 59 were similarly divided into either an annual mammography or no mammography group; both the mammography and control groups in this age bracket, however, were offered annual physical exams. Overall, 22 percent of screen-detected invasive breast cancers were over-diagnosed in the mammography groups. The researchers suggested a reassessment of the value of mammography screening.

I must also note here that this study employed film, rather than digital, mammography. While both mammography methods utilize X-ray imaging, digital is now considered better for screening than film is, and also uses less radiation. However, radiation is still carcinogenic, and can add up year after year.

Through another 2014 (non-randomized) study published in The Journal of the American Medical Association (JAMA), though, researchers determined that adding an additional screening tool called tomosynthesis to digital mammography helped increase cancer detection rate while decreasing recall rate (proportion of patients who need additional imaging based on the initial screening exam result).

While this result, initially, sounds promising, I’m concerned about the extra carcinogenic radiation that tomosynthesis adds to the digital mammography program: it essentially doubles the dose. And while the researchers “cited excessive false-positive results, limited sensitivity, and potential for over-diagnosis” as reasons why mammography has recently drawn mainstream criticism, they made no peep about concerns over existing radiation from annual mammography exams. Again, all that radiation adds up.

What to take from these recent studies? Even though they were not offered to the younger (control) group of women in the 25-year Canadian study, annual physical breast exams and regular self-examination are good preventative strategies for women ages 35+. While most breast cancers, according to the CDC, are found in women over 50, 11 percent of cases do occur in women under 45; hence, annual physical check-ups at the family doctor or OBGYN are not unnecessary for younger women, in my book. Get checked – without the radiation – just to be safe.

The tomosynthesis study, while limited as a retrospective analysis – not a randomized controlled trial, does show us that mammography is making some progress as a screening tool, and that tomosynthesis may be especially useful for those with cancer concerns following a physical breast exam.

Should You Get an Annual Mammogram?

Whether or not to get an annual mammogram – and starting at what age – is an individual decision each woman needs to make with the help of her doctor. My suggestion is that women empower themselves by learning as much as possible about mammogram screening from a variety of sources (while this article is a good place to start, it is by no means a comprehensive analysis of the issue). Know the benefits; know the risks.

The National Cancer Institute has made available online a Breast Cancer Risk Assessment Tool which may be of use in making decisions involving mammograms. In addition to mammogram screening, some techniques for early detection include (as mentioned earlier) self- and physician-conducted breast exams, ultrasound, digital mammography, magnetic resonance imaging (MRI), and thermography.

A form of infrared imaging used to detect heat, thermography can indicate the presence of inflammation, which often is present in pre-cancerous and cancerous cells; it can also be very useful in early detection of any breast abnormalities. Provided you can find a screening center that utilizes thermography, it’s my screening machine of choice.

You can also learn more about risk factors for breast cancer in younger women by visiting this Centers for Disease Control web page.

Breast Cancer Treatment is an Individual Decision

If a woman is diagnosed with breast cancer, she should learn as much as she can about it. Breast cancer certainly can be treated in a variety of ways, not just the traditional methods of surgery, chemotherapy and radiation. If she chooses to undergo conventional therapies, a woman should consider some form of alternative therapy that will compliment her healing. The decision about which therapies are right for her can be difficult – every woman needs to do her own homework and due diligence when it comes to choosing cancer treatments.

I’ve treated many women who have integrated strategies from both the conventional and alternative models, and strongly recommend Knockout, by Suzanne Somers, as referential reading. Somers’ book is a strong message to women that, when it comes to breast cancer, you’ve got to treat physical, spiritual and emotional aspects of the illness. I also personally know many of the experts in Knockout and that many of their recommended alternative therapies do work. For instance, I would send my patients with breast cancer to Dr. Stanislaw Burzynski, of the Burzynski Clinic in Houston, Texas. I also recommend Oasis of Hope centers in Irvine, California and Tijuana, Mexico. While entirely different facilities, both Burzynski Clinic and Oasis of Hope offer wonderful options for women who want either less toxic alternatives to conventional breast cancer treatment, or alternative adjunctive therapies to support chemotherapy, radiation and/or surgical treatments.

Breast Cancer Prevention

The best way to fight breast cancer is to try to avoid developing it in the first place through anti-cancer lifestyle choices. In Women’s Bodies, Women’s Wisdom Board-certified OBGYN Christiane Northrup, M.D. recommends sticking to an anti-inflammatory, high-fiber diet rich in phytonutrients, cruciferous vegetables and omega-3 fats, maintaining a healthy weight, and getting enough sleep as well as moderate daily exercise to promote healthy breast tissue. Limiting consumption of alcohol and non-organic dairy products (which do not contain rGBH, a GMO product also known as bovine growth hormone) can also help women avoid excess estrogen (relative to progesterone) which may be associated with greater breast cancer risk. Other preventative measures include stress management and creating emotional health as well as supplementation with coenzyme Q10, vitamin D, and selenium.

Additional Resources:

  • American Cancer Society
  • NIH National Cancer Institute: Mammograms
  • Dana Farber Cancer Institute
  • American Association for Cancer Research
  • Memorial Sloan-Kettering Cancer Center
  • National Breast Cancer Foundation
  • Susan G. Komen for the Cure

References:

© 2014 HeartMD Institute. All rights reserved.

Leave a Reply

11 Comments

  1. Carol

    on July 24, 2014 at 9:05 pm

    Reply

    Thank you, Dr. Sinatra, for your views on mammography. I was pleased to see that you recommend thermography as your choice of screening tool. I am age 63 and gave up mammograms years ago. I always felt that squeezing your breasts between two plates like a pancake and shooting them up with radiation never made sense. I have used thermography in recent years, even though my health insurance doesn’t cover it. Men would never submit themselves to such a barbaric practice such as mammography.

  2. Terri

    on July 24, 2014 at 11:00 pm

    Reply

    Totally agree with Carol and your info is right on. I never had a mammogram. My older sister died of breast cancer and had a mammogram but cancer not detected until she had grown into stage 4 bone cancer. I then did a lot of research and found the best path for me and am sold on http://www.clinicalthermography.com

  3. Sandy

    on October 1, 2015 at 4:27 pm

    Reply

    What about women over 75? I didn’t note any recommendations here.

  4. Stacy

    on October 1, 2015 at 5:01 pm

    Reply

    I’m so pleased to see you recommend thermography. I’ve been doing that now for 2 years instead of the mammogram that my gynecologist pesters me to get every year, even though I am under 50! I told her the new guidelines do not recommend mammogram until 50, but she still said I should go. I told her I was getting a thermogram, and she said that’s fine but it should be in addition to mammogram. She went against the newest guidelines. Luckily, I am an informed person because clearly I can’t depend on my own doctor. With fibrocystic breast tissue, thermography is far better.

  5. Louise Rigano

    on October 1, 2015 at 5:05 pm

    Reply

    I had breast cancer in 2008. I was doing mammograms every year. I had lumpectomy. I did 3 weeks of radiation, not the standard 6 weeks. I found out about thermographys and went 3 hours away to do them. They are the top of the line. After the radiation something showed up on the test and doctor recommended I do an ultrasound. I was refused the ultrasound by the radiologist because I would not do a mamgram. Had to drive 3 hours to do an ultrasound recommended by the doctor who does the thermography. I appreciate you Dr Sinatra for telling the people what our choices are. There are doctors who care about us not big pharma.

  6. Dana Allison

    on October 1, 2015 at 8:24 pm

    Reply

    In this report you only talk about what affects women under 60 years. What about the women who are nearing 90 years, and above? Is it necessary for them to have annual mammograms, or, even advisable? After all, they have had many more years to have been subjected to radiation, for various reasons! Does the dentist’s X-rays contributed to the tally?

  7. Leone E.

    on October 2, 2015 at 2:25 am

    Reply

    I have had mammograms but because of the pain involved I chose thermography because I have
    fibrosistic disease. My breasts are very sensitive and I’ve heard that this disease rarely presents cancer. Is that true? Please answer, Dr. Sinatra Thank you

  8. HMDI Editor

    on October 2, 2015 at 2:40 pm

    Reply

    Hi Dana, As you suggest, with every mammogram comes increased risk of breast cancer due to the radiation administered. For a 90-year old woman, the risk of an annual dose of radiation may not be worth the benefit. An annual breast exam by a physician is recommended for such women, as is thermography; mammograms on a case-by-case basis.

    Yes, dental x-rays – like all x-rays – contribute to cumulative radiation exposure.

  9. HMDI Editor

    on October 2, 2015 at 2:52 pm

    Reply

    Hi Leone, Yes, fibrocystic changes don’t increase risk of breast cancer, and women with fibrocystic breasts tend to remain free of breast cancer. Multiple lumps and breast tenderness or pain are actually better signs, as they indicate fibrocystic changes – as opposed to one lump and no pain, which could mean cancer. Thermography is a good choice.

  10. Marilyn P

    on October 23, 2015 at 3:21 am

    Reply

    I had found a lump in my breast it felt different it had a knot ,I had surgery left a dimple but I lived and my sister died a year after her mammogram she went to the doctor it had got in her limp glands surguary spread all through her she died within a year.you need to test yourself and if it feels like it is cancer get help before its to late. You can’t trust all doctors .she was 75 so even if you are 60 or 70 you get cancer.

  11. HMDI Editor

    on October 23, 2015 at 6:06 pm

    Reply

    Hi Marilyn, It’s great to hear about your success with treatment. We’re also sorry for your loss. Thanks for sharing.

Leave a Reply

Your email address will not be published. Required fields are marked *

Most Popular